Implementing Image-Guided Brachytherapy (IGBT) For Cervical Cancer in Resource-Limited Settings: An International Multicentric Cross-Sectional Study of Resource and Workflow Impact.
Varsha Hande, Sandra Ndarukwa, Alfredo Polo Rubio, Daniel Berger, Yavuz Anacak, Maria Sucharski, Jerickson Abbie S Flores, Jai Prakash Agarwal, Susan Chitonje Msadabwe, Eugenia Gamboa, Julius David Mwaiselage, Enkhtsetseg Vanchinbazar, El Majjaoui Sanaa, Chynara Batyrkanova, Amira Shami, Senem Alanyali, Nigar Aliyeva Sabaddin, Vladyslav Sukhin, Blanka Jaksic, Tomoaki Tamaki, Supriya Chopra
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引用次数: 0
Abstract
Background: Use of image-guided brachytherapy (IGBT) in cervical cancer improves patient outcomes. However, implementation in resource-limited settings is challenging due to limited capacity upscale, absence of workflow enhancement strategies, and financial barriers. Optimizing workflows is essential, yet the relationship between workflow efficiency and IGBT uptake remains unclear.
Methods: This cross-sectional study examined brachytherapy (BT) workflows across 14 nationally representative centers. Standardized forms collected data on infrastructure, treatment workflows ((A): Conventional two-dimensional (2D) X-Ray-Guided BT, with point-A-based fractions planned using 2D X-ray imaging, (B): Standard intracavitary (IC) three-dimensional (3D) IGBT, with fractions planned using computed tomography (CT)- or magnetic resonance (MR)-based imaging with volume-based prescriptions, (C): Advanced 3D IGBT, with fractions delivered using advanced IC or intracavitary-interstitial (IC-IS) techniques and planned using CT- or MR-based imaging with volume-based prescriptions.)), procedural times, anesthesia, imaging, and treatment planning. National BT resource data was also collected. Recommendations were developed to optimize workflows and facilitate IGBT transition.
Findings: A total of 365 workflows were analyzed, wherein workflow B was most common (51%). Median procedure times were 2 hours 08 minutes (Interquartile range (IQR) 1 hour and 7 minutes), 2 hours 35 minutes (IQR 1 hour and 51 minutes), and 4 hours 16 minutes (IQR 2 hours and 33 minutes) for workflows A, B, and C, respectively. Using sedation instead of full anesthesia shortened workflows by a median of 35 minutes. BT machine demand, based on national cervical cancer incidence, ranged from 0.2 to 9.5; four countries had low (< 0.5), two moderate (0.5 - 1.0), and eight high demand (>1.0). Resource- and context-specific recommendations for IGBT transition were provided.
Interpretation: BT workflows varied widely. Substantially increased procedure times and resource use were observed with advanced workflows. Findings highlight opportunities to improve efficiency through anesthesia choice, imaging strategy, and planning workflow optimization. Implementing context-specific strategies will be crucial for IGBT transition.
Funding: Funding from the XXXX, in collaboration with XXXX and participating sites.
期刊介绍：
International Journal of Radiation Oncology • Biology • Physics (IJROBP), known in the field as the Red Journal, publishes original laboratory and clinical investigations related to radiation oncology, radiation biology, medical physics, and both education and health policy as it relates to the field.
This journal has a particular interest in original contributions of the following types: prospective clinical trials, outcomes research, and large database interrogation. In addition, it seeks reports of high-impact innovations in single or combined modality treatment, tumor sensitization, normal tissue protection (including both precision avoidance and pharmacologic means), brachytherapy, particle irradiation, and cancer imaging. Technical advances related to dosimetry and conformal radiation treatment planning are of interest, as are basic science studies investigating tumor physiology and the molecular biology underlying cancer and normal tissue radiation response.
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